Test 3- The Drugs Flashcards
what are the generic names of amides
articaine bupivicaine mepivicaine lidocaine prilocaine
what are the trade names for articaine
articadent orabloc, septocaine, zorcaine
what are the trade names for bupivicaine
marcaine, vivacaine
what are the trade names for lidocaine
lingospan, octocaine, xylocaine
what are the trade names for mepivicaine
carbocaine, isocaine, polocaine, scandanest
what is the trade name for prilocaine
citanest
what letter will inciate that it is an amide
an I before caine
what is novacane
ester
what is the trade name for novacane
procane
what are examples of relative contraindications
-atypical plasma cholinesterase
-methemoglobinemia
-significant liver dysfunction, liver dysfunction, cardiovascular disease
-clinical hyperthyroidism
-
what should you avoid with someone who is ASA III-IV
racemic epi gingival retraction cord
what should you do with someone what has a significant liver or renal dysfunction or cardiovascular disease
use less LA
what should you not do with someone who has methemoglobinemia
do not use prilocaine
what should you not use with someone who has atypical plasma cholinesterase
esters
what should you be careful with with someone who has clinical hyperthyroidism
vasoconstrictor amount
what are the absolute contraindications
- a true documented allergy
- bisulfite allergy
what should you do if your pr has a bisulfite allergy
use local without a vasoconstrictor
what are people allergic to who have a bisulfite allergy
the preservative
what is duration of LA influenced by
- individual response (bell curve)
- accuracy of admin
- status of oral tissue
- anatomical technique
- faulty technique
- type of injection
what are the two greatest things that influence the duration of LA
faulty technique, anatomical variation
what are normal responders
the majority of people respond of a predictable manner
what are hyper responders like
they get very numb and stay numb for long periods of time
what are hypo responders like
the barely feel numb and lose the anesthesia faster
what would cause a parasthesia
a 4% solution over a 3 or 2%
why would you use a 1:50,000 epi solution
for good hemostasis
What type of injection lasts longer
nerve block
what type of injection is shorter in duration
infiltration
what is the other name for an infiltration
supraperiosteal
what does less volume of an anesthetic do
decreases duration
does more volume of anesthetic increase duration
not necessarily
what should you use for epi sensitive patients
prilocaine
what can prilocaine do to the blood
it reduces its blood oxygen carrying capacity
what are the unsubstantiated claims about articaine
-parasthesia
increased quality
provides pulpal and ling anesthesia via inflitration in adult mandible
where should you never use articaine
in a IA
what drug lessesns the patients needs for post op opiod analgesics because of its long duration
bupivicaine
what does the percentage on the carpule indicate
the amount of LA mg per ml of anesthetic
how much LA in a 2 % solution
20 mg/ml
how much LA in one carpule with 2% solution
36 mg of drug
if there is 36 mg of drug in on 2% solution carpule how much in 2
72 mg of drug
who is tissue trauma common in with LA
very young and very old
who are the medically compromised
changes in liver function
plasma protein building
blood volume
those that have biotransormation and LA distribution problems
The MRD should be decreased in which individuals
debilitated
elderly
medically compromised
kids
what is the concentration like in topical anesth
it is greater than injection LA
what does the high concentration of topical facilitate
diffusion through mucous membrane
how far down does topical penetrate
2-3 mm
what is the mode of action of topical LA
-insoluble in water
slowly absorbed into cardiovascular system which decreases chance of toxicity
what is the site of action of topical LA
mucous membrane
is spray topical recommended
no
what kind of anesthetic is an EMLA
an amid
what is another name for EMLA
eutetic anesthetic
what is an example of an EMLA
Oraquix
how do emla/eutetic anesthetics work
they soak through intact epidermal tissues
what are EMLAs
a highly concentrated anesthetic
does EMLA provide pulpal anesthesia
yes a little
what factors are important when selecting LA
- length of time
- potential for pain after
- shorter acting for children or mentally disabled
- hemostasis
- contraindications
what should epi sensitive patients be limited to
2 cartridges of 1:100,000 epi per appt (MRD is .04mg)
who are the epi sensitive pts
cardiovascularly compromised and hyperthyroid patients
what anesthetic is preferred in most non surgical dental procedures
2% lido with 1:100,000 epi
what does 2% lido with 1:100,000 provide
as much duration and depth as 1:50,000 with a lower concentration of epi
what is mepivicain plain always
3%
What are local complications of LA
hematoma, trismus needle breakage parasthesia facial nerve paralysis soft tissue injury pain on inj burning on inj infection edema sloughing of tissues
where does a PSA hematoma usually manifest
lower aspect of the mandible
where is the weakest place on a needle
the hub
why do needles usually break
bending the needle
what gauge of needle is best
27 gauge
what else can cause a broken needle
sudden pt movement
what is paresthesiA
numbness that lasts longer than it should
what does paresthesia feel like
numb or frozen, swelling, tingling, itching
what are the oral dysfunctions of parasthesia
tongue biting, drooling, loss of taste, speech impediment
how long does parasthesia last
can last for days or months usually 2 mo
what is the main cause of parasthesia
trauma to any nerve
what are other causes of parasthesia
-contaminated LA solution
-trauma to nerve sheath
insertion of needle into foramen
type of LA usedd
what are symptoms of parasthesia
irritation, resulting in edema and increased pressure by nerve leading to parasthesia
what is the most common cause of parasthesia
contaminants
what do contaminants to LA produce
long term trauma to the nerve
what is parasthesia
loss of sensation
what is hyperesthesia
increased sensitivity to noxious stimuli
what is dysesthesia
bad anesthesia, painful sensation to usually non noxious stimuli ex zinging instead of numbness
what do para, hyper and dysesthesia usually resolve
8 weeks
what is muscle droop
ptosis
what is the cause of facial nerve paralysis
deposition of LA in deep lobe of parotid gland which contains terminal branches of the facial nerve
where is the parotid located
posterior border of mandibular ramus
how long does is take the parotid to become un numb
at the same rate the anesthetic should
what will happen to the facial muscles in facial nerve paralysis
loss of motor function of facial nerves (not masticatory), unilateral paralysis, unable to close one eye
what is trismus
prolonged spasm of jaw muslces, normal opening of jaw is restricted (lock Jaw)
what is the cause of trismus
too many needle pokes trauma to muscles or blood vessls in infratemporal fossa hemorrhage low grade infection after injection barbed needle
what is a hematoma
effusion of blood into extravascular spaces, when you nick an artery or vein
why is a hematoma a problem
bruise, trismus and pain, inconvenience and embarrassment
why can a patient experience pain on injection
careless technique
dull needle
rapid deposition of solution
barbed needle
why may a patient feel burning on injection
ph of solution
rapid injection
contamination of cartridge
solution too hot
what is there a possible higher likelihood of with burning on injection
trauma
how do you prevent burning on injection
slow deposition
what is the rate you shouldnt exceed when injecting
1.8 ml/min
where does the potential toxicity of a drug rest
in the hands of the user
do drugs have a single action and are devoid of toxicity
no
what are predesposing factors for systemic complication
age, weight, other meds, sex, presence of disease, genetics, mental attitude and environment
what should be decreased if they have predisposing factors
MRD
what are causes of overdose
- slow biotransformation
- unbiotransformed drug too slowly eliminated through kidneys
- too large of dose admin
- absorbtion from inj site unusually rapid
- inadvertent intravascular admin
what should you do to avoid overdose
aspirate
what can someone sue for
standard of care
what is the standard of care
minimal level of acceptable performance
how is the standard of care measured
locally and nationally
what is the best form of defense in dental office
documentation
what is important to document in documentation
lack of compliance or now shows
how long do you have to sue someone in utah
from the time a problem is discovered up to 2 years
how long do dental offices maintain records
7 years
if a pt refuses xrays and you document they didnt want them does it exclude you from legal matters
no
malpractice only covers what
practicing within scope of practice
if your licence is on probation can you still work
yes
if you commit a crime can DOPL take your licence
yes
what does buffered LA do
changes pka so it works faster
what does phentolamine mesylate do
kicks cations off of gates so na pumps work to get un numb faster
